APPLICATION DEADLINE:

Transcription

1 Health Careers Program Summer Opportunities Lowcountry Area Health Education Center (AHEC) is a non-profit organization that works with high school and college students to promote diversity in healthcare. We offer summer enrichment programs to expose students to the many opportunities available in healthcare. T h e a pplication for the summer internship program is now available! To familiarize you with the details of this experience, please review the information below. To find out more details about our organization (specifically our Health Careers Programs) visit Internship Program The internship program is an experience offered to disadvantaged and underrepresented minority graduating high school seniors and college students interested in a health professions career. Once accepted, students are placed at a healthcare facility in the Lowcountry. Lowcountry counties include: Allendale, Bamberg, Barnwell, Beaufort, Berkeley, Calhoun, Charleston, Colleton, Dorchester, Hampton, Jasper, and Orangeburg. Interns will observe a healthcare provider over the course of four weeks and present a PowerPoint presentation about their experience. This program begins July 1 st and ends July 31 st. Students are required to attend mandatory meetings in Walterboro, SC throughout their experience. Please be advised that some healthcare facilities may require that interns cover the cost of medical exams, background checks, etc. before beginning their experience. At the completion of this program, students will receive a $500 stipend if all requirements are fulfilled. Program Coordinator Contact Information: Please direct all questions to Katura Williams (williamsk@lcahec.com) or Tracey Wilson (wilsont@lcahec.com). Inquiries may be submitted by or phone ( ). Submit application, transcript, essay, and two recommendation forms along with non-refundable application fee of $25 (Cashier s Check or Money Order) to: Walterboro, SC 29488

2 Lowcountry Area Health Education Center 2016 SUMMER INTERNSHIP PROGRAM APPLICATION July 1 st July 31 st Eligibility: Applicants are required to: A. Be in good academic standing. B. Demonstrate a sincere interest in a specified healthcare field. C. Understand that ALL internship sites will be located within counties included in the specified AHEC s region. (Lowcountry Region: Calhoun, Orangeburg, Bamberg, Charleston, Colleton, Jasper, Beaufort, Allendale, Berkeley, Hampton, Dorchester, Barnwell) D. Understand that the application process for the AHEC Summer Program is competitive. Submission of this application does not guarantee acceptance into the regional Internship Program. E. Understand that you may incur additional fees by a healthcare facility if accepted as an intern. F. Be a graduating high school senior or undergraduate student. G. Provide transportation to/from internship placement site and AHEC office in Walterboro, SC for mandatory meetings if accepted. Directions: Applications must be TYPED OR PRINTED IN BLUE OR BLACK INK. A non-refundable, $25 application fee must accompany the application. DEADLINE: ALL applications must be postmarked by February 20, Completed applications must include: º An OFFICIAL copy of all undergraduate transcripts. This document must be supplied by the registrar of your academic institution. º TWO completed recommendation forms (one form must be completed by a mentor/counselor/clergyman and the second form must be completed by an adult who is familiar with your academic work and character) Recommendations are NOT accepted from family members. Each recommendation form must be enclosed in a sealed envelope by the recommender. ALL SECTIONS OF THE APPLICATION MUST BE COMPLETED. INCOMPLETE APPLICATIONS WILL NOT BE REVIEWED. Submit application, transcript, essay and two recommendation forms along with non-refundable application fee of $25 a Cashier s Check or Money Order) to: Walterboro, SC 29488

3 Lowcountry Area Health Education Center 2016 SUMMER INTERNSHIP PROGRAM APPLICATION July 1 st July 31 st A. GENERAL INFORMATION: 1. Are you considering taking a summer school course? YES NO Possibly 2. Are you planning to maintain (or apply for) employment this summer? YES NO Possibly 3. Placement Details: º I will be able to provide daily transportation to/from placement site. YES NO º Indicate your preference of County: City: º Indicate your career interest: Choice 1: Choice 2: 4. Are you willing to serve as a role model for a high school student during the academic term? YES NO 5. Does AHEC have permission to use your quotes or photographs for its website, brochures, or other publications? YES NO B. DEMOGRAPHIC INFORMATION: 1. Name 2. Home Address Last First Middle Number Street Name City State Zip County 3. Is your home address the same as your mailing address? YES NO If no, please provide your correct mailing address below. Mailing Address P.O. Box City State Zip 4. Age Date of Birth / / Place of Birth Mo./ Day / Yr. City/County State 5. Sex: Male Female 6. Home Telephone: ( ) Cell phone:( ) Dorm room telephone: ( ) Address: 7. Ethnicity: African American Caucasian American Indian Asian Hispanic Pacific Islander Native Hawaiian Latino Alaska Native Other

4 APPLICATION FEE: $25 (non-refundable) SUBMISSION DEADLINE: February 26, 2016 C. ACADEMIC INFORMATION 1. School Name: 2. School Mailing Address: City State Zip County 3. Current High School (HS) Students Only-Classification: 12 th (accepting only graduating high school seniors) Guidance Counselor s Name: Are you currently receiving Free or Reduced lunch? YES NO 4. Current College Students Only-Classification: Freshman Sophomore Junior Senior High School Name HS Grad Year: Major:Minor/Concentration: Exp Grad Year: Did you receive the Pell grant for the current school year? YES NO 5. First day of Class for School Year: 6. List all educational institutions (most recent first) you have attended: Name of School Location Graduation Date Degree Earned 7. List any honors/distinctions received for scholastic achievements: 8. List any extracurricular and/or community service activities (EXCLUDING jobs held during your high school/college years). Please INCLUDE any AHEC activities.

5 D. WORK EXPERIENCE: List any jobs (including summer employment) you have held in the past two years. E. FAMILY: Position Employer Dates of Employment Hrs./week 1. Number of immediate family members currently living in your household (INCLUDING SELF). Brothers Sisters Parents/Guardians TOTAL (INCLUDE SELF) 2. Will you be the first family member to graduate from a college or university in your household? to to YES NO F. ESSAY: Using a separate sheet of paper, type a brief essay ( words) which addresses the writing prompt below: Describe your plans for becoming a healthcare professional. Please include details on academic coursework, extracurricular activities, and enrichment opportunities (ex: internship, summer programs, etc.) Submit application, transcript, essay, and two recommendation forms along with non-refundable application fee of $25 (Cashier s Check or Money Order) to: Walterboro, South Carolina 29488